Kyphoplasty/Vertebroplasty in Houston
Vertebroplasty and kyphoplasty are both minimally invasive procedures used to treat vertebral compression fracture (VCF), which are breaks in the vertebral bodies of the spinal column. If there is a fracture of a vertebral body, the bone is often compressed, causing pain. Compression fractures often cause a collapse of the vertebrae of the spine, and are related to osteoporosis (weak, thin bones). Osteoporosis is a disease that results from loss of bone density, strength, and mass.
To treat painful vertebral compression fractures, the orthopedic specialist will use either vertebroplasty or kyphoplasty. These procedures are only done when the patient fails on conservative measures, such as pain medication, bed rest, and bracing. With vertebroplasty, the doctor uses image guidance to inject a cement mixture into the fracture by way of a hollow needle. In kyphoplasty, a balloon is inserted into the cracked bone to create a space or cavity, and then cement is inserted to that cavity after the balloon is removed.
Candidates for Vertebroplasty and Kyphoplasty
For the highest level of success, vertebroplasty and kyphoplasty should be completed with eight weeks of the initial fracture. These procedures are performed on patients who:
- Have failed on conservative treatment measures.
- Are elderly, frail, or have frail bones.
- Suffer from osteoporosis related to osteoporosis, long-term steroid therapy, or a metabolic disorder.
- Have a vertebral compression related to a malignant mass.
Before the Procedure
Before vertebroplasty or kyphoplasty, a clinical evaluation is done to evaluate and confirm the compression fracture. This may include diagnostic tests, laboratory tests, a physical examination, x-rays of the spine, a bone scan, and/or magnetic resonance imaging (MRI). Bone-strengthening medication is given during treatment along with other medications. Make the doctor aware of any medications you are taking and if or not you have allergies to anesthesia, contrast dye, or medicines. The doctor will advise you to stop any blood thinning agents prior to the procedure, including Coumadin, anti-inflammatory agents, and aspirin. Additionally, a woman must inform the doctor if she is pregnant or there is a possibility she may become pregnant.
On the day of the procedure, take your usual medication with sips of water. However avoid drinking juice, milk, or cream-based drinks. Schedule to have a relative or friend drive you home, and plan to be off work for at least six weeks.
During the Procedure
During vertebroplasty and kyphoplasty, devices are used to monitor your heart rate, breathing, and blood pressure. You will feel a scant burning sensation when the intravenous (IV) catheter is stared. The medical personnel will use this to give you sedation and keep you relaxed. The back region is shaved, cleansed, and numbed for sanitation purposes. During the procedure, the only sensation you will feel is pressure or tapping, as the trocar is advanced into the bone. Pain relief is immediate for many, but only reduced for others. However, full effect could take a few days.
Benefits and Risks of Vertebroplasty and Kyphoplasty
Vertebroplasty and kyphoplasty has the benefits of increased functional abilities, ability to return to previous level of activity, and alleviation of pain. As with other spinal procedures, there are certain risks associated with vertebroplasty and kyphoplasty. These include risk of infection, leakage of orthopedic cement, bleeding, increased back pain, paralysis, and numbness. There is also the risk of an allergic reaction to the surgical products and medications used. Also, approximately 10 percent of patients develop other compression fractures from this procedure.
Burton AW & Hamid B. Kyphoplasty and vertebroplasty. Curr Pain Headache Rep. Jan 2008;12(1):22-7.
Caudana R, Renzi Brivio L, Ventura L, Aitini E, Rozzanigo U, & Barai G. CT-guided percutaneous vertebroplasty: personal experience in the treatment of osteoporotic fractures and dorsolumbar metastases.Radiol Med. Feb 2008;113(1):114-33.
Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. Mar 21 2009;373(9668):1016-24.